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Screening for intrathoracic goiters before thyroid surgery: does chest X-Rays have a place?

Abstract : Purpose: Since intrathoracic goiters (IG), either cervico-mediastinal goiters (CMGs) or mediastinal nodules (MNs), can lead to sternotomies and/or evitable reoperations, their detection is mandatory before thyroid surgery. A systematic screening by CT scan or MRI is not conceivable because of their expensiveness. We tested if conventional chest radiography (CCR) could remain a good screening tool for IG before thyroid surgery. Methods: In this retrospective study (2554 patients), CCR usefulness was evaluated in relation with patients’ complaints, clinical examination, neck US, and anatomical and surgical findings. Results: CMGs (n = 67) and MNs (n = 42) were symptomatic in 10 and 5 patients, respectively. Clinical examination or neck US suspected their existence in 25 and 13 and 45 and 17 patients, respectively. Among the 50 IG detected by CCR (42 CMGs and 8 MNs), 4 CMGs and 2 MNs were missed by clinical examination or neck US. CCR failed to detect IG in 59 patients (54%): 25 CMGs (37%) and 34 MNs (80%). Twenty-eight IG (9 CMGs and 19 MNs) were discovered during surgery. CCR resulted in false positive in 88 out of 2445 patients (3.5%). CCR potentially avoided reoperation in two patients (a maximum saving of 6160 €, whereas the total cost of CCR was 54,895 €). Conclusions: CCR should not be used routinely for the preoperative detection of IG. Surgeons should preferably use clinical examination or neck US and directly perform CT scan when a mediastinal extension is suspected.
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Submitted on : Tuesday, April 3, 2018 - 6:51:19 PM
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Fares Benmiloud, Michel Grino, Charles Oliver, Anne Denizot. Screening for intrathoracic goiters before thyroid surgery: does chest X-Rays have a place?. Langenbeck's Archives of Surgery, Springer Verlag, 2017, 402 (2), pp.251-255. ⟨10.1007/s00423-016-1534-9⟩. ⟨hal-01753792v2⟩



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